Permit C ITY OF TIGARD ELECTRICAL PERMIT
PERMIT #: ELC2003 -00707
DEVELOPMENT SERVICES DATE ISSUED: 12/9/03
13125 SW Hall Blvd., Tigard. OR 97223 (503) 639 -4171
PARCEL: 1S134DC-00700
SITE ADDRESS: 11365 SW TIGARD ST
ZONING: R -4.5
SUBDIVISION:
BLOCK: LOT : JURISDICTION: TIG
Project Description: Install temporary service.
RESIDENTIAL UNIT TEMP SRVC /FEEDERS MISCELLANEOUS
1000 SF OR LESS: 0 - 200 amp: 1 PUMP /IRRIGATION:
EACH ADD'L 500SF: 201 - 400 amp: SIGN /OUT LINE LTG:
LIMITED ENERGY: 401 - 600 amp: SIGNAL/PANEL:
MANF HM/ SVC/ FDR: 601 +amps - 1000 volts: MINOR LABEL (10):
SERVICE /FEEDER BRANCH CIRCUITS ADD'L INSPECTIONS
0 - 200 amp: W /SERVICE OR FEEDER: PER INSPECTION:
201 - 400 amp: 1st W/O SRVC OR FDR: PER HOUR:
401 - 600 amp: EA ADD'L BRNCH CIRC: IN PLANT:
_601 - 1000 amp: PLAN REVIEW SECTION
1000+ amp /volt: > =4 RES UNITS: > 600 VOLT NOMINAL:
Reconnect only: SVC /FDR >= 225 AMPS: CLASS AREA/SPEC OCC:
Owner: Contractor:
BAPS TEMPLE WINNER ELECTRIC INC
PO BOX 41160 5950 SW PROSPERITY PK
SAN JOSE, CA 95160 TUALATIN, OR 97062
Phone: 408 - 453 -6464 Phone: 638 -5028
Reg #: LIC 14794
SUP 2825S
FEES ELE 34 -I50C
Description Date Amount Required Inspections
[ELPRMT] ELC Permit 12/9/03 $66.85
[TAX] 8% State Surcharge 12/9/03 $5.34 Elect'I Service
Elect'I Final
Total $72.19
This Permit is issued subject to the regulations contained in the Tigard Municipal Code, State of OR. Specialty Codes and all other applicable laws. All
work will be done in accordance with approved plans. This permit will expire if work is not started within 180 days of issuance, or if work is suspended
for more than 180 days. ATTENTION: Oregon law requires you to follow rules adopted by the Oregon Utility Notification Center. Those rules are set
forth in OAR 952 - 001 -0010 through OAR 952 - 001 -0100. You may obtain copies of these rules or direct questions to OUNC at (503) 246-6699 or
1- 800 - 332 -2344.
Issued By: A (C � ` _ �� Permit Signature: A * �� _ —
OWNER INSTALLATION ONLY
The installation is being made on property I own which is not intended for sale, lease, or rent.
OWNER'S SIGNATURE: DATE:
CONTRACTOR INSTALLATION ONLY
SIGNATURE OF SUPR. ELEC'N: -y�- DATE:
LICENSE NO: C
Call 639 -4175 by 7:00pm for an inspection the next business day
Electrical Permit'A C ' lication FOR OFFICE USE ONLY .
Received Electrical
U u v Date/By -0 3 � 2 Penrut No C�le_..... o ' 7 lQ 1
city' f Tigard DEC 2 :23 Planning Approval Sign
y g Q C ,� L Date/By PermitNo..
13125 SW Hall Blvd. Plan Review Other
Tigard, Oregon 97223 Date/By Permit No.:
T r Post - Review Land Use
Phone: 503 - 639 -4171 Fad I � (2.A
tilii NI UIVIbION Post-Review
'I A Date/By: Case No.:
Internet: www.ci.tigard.or.us e i Al C
Contact s ® See Page 2 for
24 -hour Inspection Request: 503- 639 -4175 -- Name/Method: / I _ Supplemental Information.
° '.' - �. ,-r _;A, :,TYTE.OF�WORK '-: .r r%'-x ._, =' . .. ; .`�r' . L?- VIEW,, ,� rt ::'''''',.t-.);...::...c-
_ � _ . •:. ., . � « . � .' -� ; � AAi#RE (plea'se,•check:all tFiat aPPIY) =t_
.•..
IE New construction ❑ Demolition ❑ Service over 225 amps- ❑ Health -care facility
❑ Addition/alteration/replacement ❑ Other:
commercial ❑ Building over er 10,000
� ' _` h . a ❑ Service over 320 amps -rating of ❑ Building over 10,000 square feet,
_ r rt CATEGORiY O,F CO.NTSTRUCiUtO z; ::0 ' ` = . . ':+`'; 1 & 2 family dwellings four or more residential units in
❑ 1 & 2- Family dwelling ❑ Commercial/Industrial ❑ System over 600 volts nominal one structure
El Building over three stones ❑ Feeders, 400 amps or more
❑ Accessory Building ❑ Multi- Family
❑ Occupant load over 99 persons ❑ Manufactured structures or RV park
❑ Master Builder [3c� Other: ❑ Egress/lighting plan ❑ Other:
r_ >.?! — 1 Submit sets of plans with any of the above.
�:�- - „ -,- ,_ ', Ti :��: =70B; SITE' 7�tF 07ilVIA�ZON�andiLOCA ,T)`ON�`3_ °��_"�''_ `• �,_ — p y
Job site address: J 3� $ ' � pR a $y The above are not applicable to temporary construction service.
/ 6. :. „ e ;,-'_ ;'8' :r'; h.u' : _, - FEE *iSGHFIDT3I,E: r , ;N . i_ 4.r:' ` ,
Suite #: Bldg. /Apt. #: Number of inspections per permit allowed
Project Name: S 4 PS
Ten--P Description Qty Fee (ea.) Total
New residential- single or multi- family per j
Cross street/Directions to job site: dwelling unit. Includes attached garage.
Service included:
1000 sq. ft. or less 145.15 4
Each additional 500 sq. ft. or portion thereof 33.40 1
Limited energy, residential 75 00 2
Subdivision: Lot #: Limited energy, non residential 75.00 2
Tax map /parcel #: Each manufactured home or modular dwelling
N''.'''''' :ri xr` �+; <+ t - ? _ :i• '' service and/or feeder 90.90 2
Y ::-•�. � w� DESCRIPT1= 015aOF�WQR1C� : -'` .: �� •-_ - �f
Services or feeders - installation,
7 e4111/2 .. g I ¢G /e4 /G,A t— �Q ✓k c--L>.— alteration or relocation:
200 amps or less 80.30 2
201 amps to 400 amps 106.85 2
401 amps to 600 amps 160.60 2
DPROP,ERTY OWNER ,,: r '>.ENA/4— • ., ; , _ _ 601 amps to 1000 amps 240 60 2
Over 1000 amps or volts 454.65 2
Name: (-or r S Te y ,.,. pi Reconnect only 66 85 2
Address: P(S' Bqw 4 4 1 Z 6 6 Temporary services or feeders - installation,
alteration, or relocation:
City /State /Zip: ,S-ow c \-os- c C A- q 3/ Co 200 amps or less / 66 85 G 6• yo 1
Phone: '413% q6 6e-/6.--/ Fax: 201 amps to 400 amps 100.30 2
®0. } ; r i - „ r 401 to 600 amps 133 75 2
- K.4c rv,, : :.: '•rt_ , ❑.CO fT 'CT PE ,. RSON - .`, `•
Branch c - new, alteration, or
Name: extension per panel:
Address: A Fee for branch circuits with purchase of
service or feeder fee, each branch circuit 6.65 2
City /State /Zip: B. Fee for branch circuits without purchase of
service or feeder fee, first branch circuit 46.85 2
Phone: Fax: Each additional branch circuit 6.65 2
E -mail: Misc.(Service or feeder not included) -
COS�H� CTOR „> Y A� ° o Each pump or ungation circle 53.40 2
E ach sign or outl lighting 53.40 2
Job No: Signal circuit(s) or a limited energy panel,
Business Name: of 1 Nl�e/t. 6- / eciA Descri
- or extension Page 2 2
Descriptiti or
Address: 66.6 S W P2os Pe�' P *2� /2)
City/State/Zip: l �Ca��w �- Z Each additional inspection over the allowable in any of the above:
`J 13 Cl -7W Per inspection per hour (min. 1 hour) 62.50
Phone:<ro& 63 $ 60 Ze Fax: 5o3 65x .z97. Investigation fee:
CCB Lic. #: )I.') -1 Lic. #: ?„‘-j-156 C. other:
' -: '- viEfectric i *,: ;xA4 : „.''.'- ..j :.4
Supervising electrician Subtotal $ 1a6,.?
signature required: fi� ”
Q,L( Plan Review (25% of Permit Fee) $
y
Print Name :3. ., 1 ) ti. Lic. #: 2Z State Surcharge (8% of Permit Fee) $ 5,3 2/
TOTAL PERMIT FEE $ 72. 1 CC
Authorized , (`�,� /i Notice: This permit application expires if a permit is not obtained within
Signature: W( D ate. 1 .,' 3 3 180 days after it has been accepted as complete.
*Fee methodology set by Tri -County Building Industry Service Board.
cN*1 b'J cir ll
(Please print name)
i \Dsts\Permit Forms \ElcPernutApp.doc 01/03
Electrical Permit Application - City of Tigard
Page 2 - Supplemental Information .
LIMITED ENERGY PERMIT FEES:
RESIDENTIAL WORK ONLY:
Fee for all systems $75.00
Check Type of Work Involved:
Audio and Stereo Systems
0 Burglar Alarm
El Garage Door Opener
Heating, Ventilation and Air Conditioning System
❑ Vacuum Systems
❑ Other
COMMERCIAL WORK ONLY:
Fee for each system $75.00
(SEE OAR 918 - 260 -260)
Check Type of Work Involved:
❑ Audio and Stereo Systems
• Boller Controls
• Clock Systems
• Data Telecommunication Installation
O Fire Alarm Installation
• HVAC
Instrumentation
• Intercom and Paging Systems
El Landscape Irrigation Control .
• Medical
0 Nurse Calls
Outdoor Landscape Lighting
Protective Signaling
Other
Number of Systems
* No licenses are required. Licenses are required for all
other installations
i:\Dsts\Permit Forms\ElcPermitAppPg2.doc 01/03
CITY OF TIGARD 24 -Hour
BUILDING Inspection L„iae: (503) 639 -4175
INSPECTION DIVISION Business Line: (503) 639 - 4171 MST
BUP
Received i 2 , <7)Pe Reques ed ` Z - p d O 4ni PM BUP
Location // ; Suite MEC
Contact Person yA Ph (J U 3) (072)p- ,502 Y PLM
Contractor Zd n Lr�
(� Ph ( ) SWR
BUILDING Tenan wne'r 64 P S / ELC - /90 70 7
Footing
Foundation Access: ELC
Ftg Drain ELR
Crawl Drain
Slab Inspection Notes:
,O SIT
Post & Beam �� � 4
Shear Anchors
Ext Sheath/Shear
Int Sheath/Shear
Framing
Insulation
Drywall Nailing
Firewall
Fire Sprinkler
Fire Alarm
Susp'd Ceiling
Loom
Roof
Other:
Final
PASS PART FAIL
PLUMBING
Post & Beam
Under Slab
Rough -In
Water Service
Sanitary Sewer
Rain Drains
Catch Basin / Manhole
Storm Drain
Shower Pan
Other:
Final
PASS PART FAIL
MECHANICAL
Post & Beam
Rough -In
Gas Line
Smoke Dampers
Final
PASS P& T FAIL
TRI
Rough -In
UG/Slab
Low Voltage
Fire Alarm
Fin Reinspection fee of $ required before next inspection. Pay at City Hall, 13125 SW Hall Blvd.
ASS ART FAIL
❑ Please call for reinspection RE: 0 Unable to inspect – no access
Fire Supply Line •
ADA
Approach/Sidewalk Date — ' � . Inspector i - . P ��°' Ext
Other:
Final DO NOT REMOVE this Inspection record from th = ob site.
PASS PART FAIL